Diplopia years after lasik

I am 29, had glasses at year old, and some patching til about age 5 for a lazy eye as I was very farsighted in both eyes.  Glasses gave me control of the lazy eye which I was able to maintain without glasses for days at a time.  At 22 I had custom lasik, now at 29 I acquired spontaneous diplopia again when using both eyes.  Dr. Burton Kushner discuss the phenomenon in detail in his march 2003 journal article http://archopht.ama-assn.org/cgi/content/full/121/3/315 .  So my optomologist found out my dilated refraction to be +.5 +.75, while undilated I am 20/20 and 20/15.  My deviation is about a 12 and I have a prism film on the left lens of my sunglasses and am getting regular glasses soon.  After reading Kushner's article I am wondering if I was properly treated by lasik surgeon, who warned me nothing about possible future diplopia.  In fact I was told at most I may reading glasses when I am older than 40.  Could my lasik surgery have been approached differently to avoid this?  Do you think I will ever regain control of binocular fusion?  Is surgery to center eye probably my only solution?  Thanks.  

[JodieJ]

I'm not an eye care professional, but I have personal experience with diplopia secondary to monovision contact lens wear.  I learned about my condition by reading one of Dr. Kushner's papers--the eye care professionals whom I had consulted previously told me that monovision couldn't possibly lead to diplopia.  (It is quite rare.  My diplopia was corrected with surgery.)  I suspect that you were never a good candidate for LASIK according to Dr. Kushner's criteria.

You might consider emailing Dr. Kushner (address on his article) for his treatment suggestions and/or a referral to a good strabismus specialist in your area.  He has been very generous with his time by responding to such requests.

[Aledrell]

I'm not sure what you mean by monovision, please clarify, as individually my eyes are great but they don't work together very well.  Is this what you mean, I've heard it called strabismus but not monovision.  Thank you for the information I will consider emailing Dr. Kushner, but just wanted some opinions as seems I may have been hosed by the clinic that did my lasik.

[Ray T Oyakawa, MD]

This is a problem that many lasik surgeon face in hyperopes and a good history help.  When you state that you where able to keep for eyes straight for days at a time implies that your prescription was off a bit.  

I would recommend that you try the dilated prescription and see if it eliminates your double vision.  If so, consider an enhancement.  You are 29 and treatment of hyperopia tends to regress/change with time.  

Dr. O.

[JodieJ]

Monovision is a correction where one eye is used for near vision and the other eye is used for distance.  It works very well for many people, allowing them to skip the reading glasses.  Dr. Kushner has written a number of articles stating that people with a history of strabismus are vulnerable to developing diplopia if they use monovision.  I was not aware of having a history of strabismus, but apparently a person can have microstrabismus as a child that is never detected.  In any case, several years after starting monovision my eyes stopped working together.  The diplopia drove me crazy, and it was corrected my shortening one muscle in one eye.

Your history of sudden onset diplopia struck me as being very similar to my own experience.  It's been awhile since I read Dr. Kushner's work on LASIK surgery.  I do recall that having a history of strabismus can make a person vulnerable to developing diplopia post-LASIK.  If, in fact, you were a poor candidate for LASIK, I seriously doubt that the clinic or your LASIK surgeon was aware of it.  Unfortunately, Dr. Kushner's findings are not universally known or accepted.

I'm not an eye care professional and know little about LASIK.  You could try Dr. Oyakawa's suggestions (above).  If your diplopia continues, you might try emailing Dr. Kushner.  He was very kind to me--giving me suggestions, sending articles, and providing local referrals.  He has also been very helpful to others who developed diplopia after LASIK.

[Aledrell]

Thanks for the advice, I was unaware a LASIK enhancement surgery was even an option.  Today was the first day used my sunglasses with prism for more than two hours and ended up with worst migraine with intense pain behind lazy eye.  Get regular glasses on the 16th and I'm looking forward to those b/c they have no prism.  
When I said I control my lazy for days, that was when I was a child and broke my glasses while waiting for new ones but always wore glasses.  Find it interesting that means I refraction was off, was I supposed to lose control of my lazy eye immediately upon removing lenses?  Is it normal for the amount diplopia deviation to vary, as it seems it does in fact it even went away for 10 mins the other day.  It also goes away if my eyes are constantly moving around our looking periphially either direction.
Amongst your circles are you finding LASIK surgeons are going out of their way to help patients that develop this issue to correct it, or is the attitude "to bad so sad, sue me?"
Note I am not one of those looking to cash in on this, I just want it fixed.  Especially since in 2003 several ads were running for $499 an eye and went out of my way to go to a reputable surgeon and paid well over $5k for my LASIK.  I was +3.25 in both eyes at time of surgery.  I went to surgeons office at on sought of diplopia and was given a specialist referral and charged $150 for it, doesn't sound on the up and up to me.

[Aledrell]

Appreciate your insight as diplopia is driving me crazy as well.  Although it sounds like our situations are different as I've never used one eye for near and the other for far.  Since Lasik in 03 my vision has been pretty good besides some increased light sensitivity and halos around street lights.  I was under the impression I'd never see another pair of glasses.  The on set of something like this is simply frightening especially when you ask optomoligists the cause and they say they don't know.  Only at my third opinion with Dr. Kushner's article in hand to find a knowledgeable doctor.  I totally agree with you though sounds like I was not a good lasik candidate and should have been for warned.

[JodieJ]

I re-read Dr. Kushner's paper about diplopia after refractive surgery.  The paper seems to address both of our conditions:  yours under the section about control of accommodation, mine under the section about monovision (although my monovision resulted from contacts rather than LASIK).  According to the paper, your diplopia could be the result of a slight change in your prescription (see Dr. Oyakawa's post above), and Dr. O's advice about trying a dilated prescription should probably be your first course of action.  It's also possible that you are experiencing late-onset diplopia (see the section about "moderate risk.")  In this case, either prism or eye muscle surgery should help you.  (Remember that I'm just a knowledgeable patient myself, not an eye care professional.)

It was my experience in 2005 that many (most?) eye care professionals were not aware of the risk factors outlined in Dr. Kushner's paper.  Maybe this hasn't changed.  If you can't find a knowledgeable doctor, ask Dr. Kushner for a referral.